Examining the Respiratory System and Sleep Apnea (L22)

Question 1

Define Orthopnoea.

How can it be relieved?

Answer 1

Dyspnoea occurring when laying flat.

Can be relieved by sitting up.

Question 2

Define Paroxysmal nocturnal dyspnoea (PND).

What is it most commonly associated with?

Answer 2

The situation where a patient wakes up breathless at night.

Most commonly associated with pulmonary oedema.

Question 3

A _____ is a whistling or sighing noise, characteristic of air passing through a narrow tube.

Answer 3

Wheeze.

Question 4

___1___ is a reflex action caused by stimulation of the ___2___ nerves in the lining of the respiratory system. It clears the ___3___ of mucus, phlegm and irritants such as dust, smoke, foreign bodies.

___1___ is a forceful expiratory burst produced by contraction of the ___4___ muscles with bracing by the intercostal muscles and sudden opening of the glottis. It is a protective ___5___ that removes secretions or inhaled solid material.

Answer 4

1. Coughing
2. Sensory
3. Airways
4. Abdominal
5. Reflex

Question 5

Define Haemoptysis.

List some causes.

Answer 5

Coughing up of blood.

• Lung cancers
• Bronchitis
• Airway trauma
• Lung abscess
• Pneumonia

Question 6

Massive _____ (loss of between 100 – 600 ml over 24 hours) is a life threatening medical emergency.

Answer 6

Haemoptysis.

Question 7

Define Pleuritic pain.

What causes it?

Answer 7

Pain which is aggravated by inspiration or coughing.

May result from:

• Inflammation of the pleura (pleurisy)
• Infection (pneumonia)
• Pulmonary embolism
• Tumour

Question 8

Define Clubbing.

What is it associated with?

Answer 8

An increased curvature of the nail with loss of the angle between the nail and the nail bed.

It is associated with bronchial carcinoma and idiopathic pulmonary fibrosis.

Question 9

Define Cyanosis.

Answer 9

The bluish discolouration of the skin and mucous membranes as a result of reduced haemoglobin.

Question 10

Read:

Normal lung appearance in Radiology.

Answer 10

• The right hemidiaphragm is 1-3 cm higher than the left.
• The trachea should be central and vertical. The left border of the cardiac shadow comprises the aorta, pulmonary artery and left ventricle.
• 2/3 of the heart lie on the left hand side of the chest.
• The heart should take up no more than half of the thoracic cavity.
• Apart from the pulmonary vessels (arteries and veins) the lungs should look black.

Question 11

Define Consolidation. (Lungs)

How does it appear on a Radiology image?

Answer 11

Consolidation is a condition where the lung tissue becomes firm and solid rather than elastic and air filled due to an accumulation of fluid, tissue debris, tumour or fibrosis.

Consolidation appears as areas of opacification, sometimes conforming to the lobe or segment of the lung in which air has been replaced.

Question 12

Define Caviation. (Radiology)

How does it appear on a Radiology image?

Answer 12

Caviation is an area of radiolucency within a mass lesion. It is a feature of bronchial carcinoma, tuberculosis, lung abscess etc.

A cavity appears as an area of black in an area of opacity (white).

Question 13

How does Fibrosis appear on a Radiology image?

Answer 13

Generalised fibrosis produces a hazy shadowing of the X-Ray with a fine reticular (net-like) or nodular pattern. Advanced interstitial fibrosis results in a honeycomb pattern with diffuse opacification, containing multiple circular transulucencies a few cm apart.

Question 14

Define and describe X-Ray Computed Tomography (CT).

What is the techniques main limitation?

Answer 14

X-ray computed tomography (CT) is a medical imaging technique that produces images of transaxial planes through the body. Conventional radiographs depict a three dimensional object as a two dimensional image.

Their main limitation is that overlying tissues are superimposed on the image. Bone and air cavities are easily seen but very little contrast is obtained in soft tissue regions.

Question 15

Define Tomography.

Answer 15

Any technique that produces an image of a single plane in a body.

Question 16

___1___ ___2___ tomography (PET) scanning is based on the fact that neoplastic cells have a greater metabolic activity and thus a higher ___3___ uptake than normal cells.

18 Fluoro-2-deoxy-___3___ (FDG) is an analogue that is preferentially taken up by neoplastic cells after intravenous injection and then emits ___1___s.

PET scanning is becoming increasingly important in the diagnosis and staging of ___4___ cancer.

Answer 16

1. Positron
2. Emission
3. Glucose
4. Lung

Question 17

Define Apnea.

Answer 17

Cessation of breath at the nose or the mouth for at least 10 seconds.

Question 18

How does Hypopnea differ from Apnea?

Answer 18

Hypopnea differs from Apnea in that there is some flow of air but there is a 30% - 50% reduction in airflow for at least 10 seconds and oxygen desaturation of at least 2% - 4%.

Question 19

Obstructive sleep apnea syndrome (OSAS) is characterized by partial or complete upper ___1___ obstruction during sleep, causing apnea and ___2___.

A diagnosis of OSAS requires at least five instances of apnea or ___2___, or both, per ___3___ of sleep.

Answer 19

1. Airway
2. Hypopnea
3. Hour

Question 20

During sleep there is reduced muscle tone of the ___1___ muscles, which are important in maintaining patency of the upper airways, and thus the airways may ___2___.

Answer 20

1. Oropharyngeal

2. Collapse

Question 21

OSAS is characterised by recurrent episodes of ___1___ airway obstruction during sleep with apnoea, arousal and sleep fragmentation.
As the patient with OSAS enters ___2___ sleep the muscles relax resulting in apnoea or hypopnoea with a fall in ___3___ saturation.

Inspiratory effort increases and the apnoea is terminated by a brief arousal from sleep. Resumption of ___1___ airflow is accompanied by loud snoring which is an inspiratory noise arising from ___4___ of the soft tissues of the orthopharynx.

Answer 21

1. Pharyngeal
2. Deep
3. Oxygen
4. Vibration

Question 22

List some cardiovascular complications of OSAS.

Answer 22

• Hypertension
• Myocardial infarction
• Stroke
• Cardiac arrhythmias
• Structural cardiac changes
• Cardiac failure

Question 23

_____ may lead to impotence.

Answer 23

OSAS.

Question 24

What general things can be done to treat OSAS?

3

Answer 24

• Weight loss
• Avoid alcohol
• Avoid sedatives

Question 25

List the drugs used to treat OSAS and describe their effects.

How effective at treating OSAS are they?

Answer 25

• Modafinil: a stimulant, may improve alertness.
• Protriptylline: a non-sedative anti-depressant which reduces the time in REM sleep.
• Progesterone: has some effect on respiratory drive.
• Acetazolamide: enhances ventilatory drive by producing metabolic acidosis.

None of the drugs are particularly effective.

Question 26

What surgery can be done to treat OSAS?

Describe it.

How effective is the surgery?

Answer 26

Uvulopalatopharyngoplasty (UPP).

Involves surgical exclusion of the redundant tissue of the soft palate, uvula and pharyngeal walls.

Effective in stopping snoring but effect on OSAS is unpredictable.

Question 27

Describe Nasal continuous positive airway pressure (CPAP).

Answer 27

This is the standard first choice treatment for OSAS. It is very effective and acts by forcing the pharyngeal airway open by blowing air into the nose via a mask counteracting the airways tendency to collapse.

Question 28

In more severe apnea there is a Bi-Level (Bi-PAP) machine which blows air at different _____. (High when inhaling and lower when exhaling).

Answer 28

Pressures.

Question 29

Name the syndrome:

A rare condition where cessation of airflow during sleep occurs (for 10 – 30 seconds) either intermittently or in cycles and leads to a reduction in blood oxygen saturation.

Collective term for Cheyne-Stokes respiration and periodic breathing.

Answer 29

Central Sleep Apnea Syndrome (CSAS).